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40 , - 2557
Probiotics and Irritable bowelsyndrome
,
Review Article
..1908 Ellie Metchnikoff
Lactobacillus bulgaricus
probiotics
Probiotics1 (for life)
probiotics
41Probiotics and Irritable bowel syndrome
(cocktails probiotic)
probiotics
( 1)
prebiotics
(fermented)
prebiotics oligosaccharides
Bifidobacteria Lactobacilli
inulin-type fructans, fructo-oligosaccharide
lactulose
Synbiotics probiotics
prebiotics probiotics
1 Probiotics
(/)
Lactomin Lactobacillus acidophilus 16 / sachet
2 x109 CFU
Intestis-flora7 109 CFU 40 / stick
Lactobacillus spp.
Bifidobacterium spp.
Streptococus spp.
Pro-digest Lactobacillus spp. 25 / capsule
Bifidobacterium spp.
TS6 2 x1010 CFU 38 / sachet
Lactobacillus spp.
Bifidobacterium spp.
42 , - 2557
Bifidobacteria Lactobacilli
(Microbiota)
300-500 (microbiota) 200
(microbiosome)
(peristalsis)
33
109 CFU/mL (terminal ileum) 1012 CFU/
mL
1 ( 1)
1
43Probiotics and Irritable bowel syndrome
1. (nutrition)
lactose alcohol
bacterial disaccharidases short chain fatty acids
(SCFAs)
2.
(integrity of epithelial barrier and mucosal immunity)
peroxides bac-
teriocin
2,3
Rome III4
3
5
44 , - 2557
(flatulence)
(bloating) (fermentation)
( 2)
(luminal microbiota)
Kassinen 22
27 real-time PCR
Lactobacilli Bifidobacteria
IBS-D IBS-C Enterobacteraciaceae,
Coliform Bacteroides IBS6
IBS IBS
2
45Probiotics and Irritable bowel syndrome
Lactobacilli Bifidobacteria
IBS 2
(mucosa-associated microbiota)
biofilm glycosylated
polysaccharides glycocalyx
pattern recognition re-
ceptors (PRRs) toll-like receptors (TLRs) apical basolateral
membrane enterocytes laminar propria den-
dritic cell
Bifidobacteria Lactobacilli
anti-inflammatory cytokines interleukin (IL-10) transforming
growth factor beta (TGF-) proinflammatory cytokines
7
1. bacte-
riocin
2. mucin
defensins
3. TLRs (
3)
probiotics
probiotics
46 , - 2557
3 probiotics
meta-analysis systematic review ( 2)
Hoyveda9 meta-analysis probiotics
(overall improve-
ments) (95% CI = 1.23-2.17)
( 4)
probiotics
probiotics
47Probiotics and Irritable bowel syndrome
2 Meta-analysis systematic reviews probiotics
()
Mc Farland et al8 2008 20 (1,414) global IBS symptoms: RR 0.77 (0.6-0.94)
abdominal pain: RR 0.78 (0.69-0.88)
Hoyveda et al9 2009 14 (1,593) dichotomous variable
7 RCTs (n=936)
OR=1.6 (95%CI, 1.2-2.2)
continuous variable
6 RCTs (n=657)
SMD=0.23 (95%CI,
0.07-0.38)
Brenner et al10 2009 16 (1,342) Bifidobacterium infantis 35624
RCT
Moayyedi et al11 2010 20 (1628) dichotomous variable
11 RCTs (n=936)
RR=0.71 (95%CI, 0.57-0.87),
NNT=4
continuous variable
15 RCTs (n=1,351)
SMD= -0.34 (95%CI, -0.60
to -0.07)
RCT, randomized control trial; RR, relative risk; OR, odds ratio; SMD, standardized mean difference
Bifidobacterium infantis 35624
OMahoney12 double blind RCT IBS
75 probiotics Lactobacillus UCC4331
Bifidobacterium infantis 35624 1x1010 cellsday
8 12
48 , - 2557
(bloating/distension)
IL-10:IL-12
B. infantis probiotics
OMahoney
Whorwell13 double blind RCT 293
B. infantis 35624 106, 108
1010 CFU/mL 4 6
6-point Likert scale B.
infantis 108 CFU/mL
1010 CFU/mL
B. infantis 35624
IBS 108 CFU/mL
Bifidobacterium animalis
Guyonnet14 double blind RCT IBD-C
267 B. animalis 1.25x1010 CFU
4 Forest plot probiotics
49Probiotics and Irritable bowel syndrome
125 S. thermophilus L. bulgaricus
6 discomfort dimen-
sion score probiotics
IBS placebo effect
probiotics
IBS 3
(p
50 , - 2557
nitric oxide
VSL number 3
VSL No.3 probiotics cocktail
lyophilized Bifidobacterium (B.
longum, B. infantis, B. breve) Lactobacillus (L. acidophilus, L. casei, L.
bulgaricus, L. plantarum) Streptococcus sailvarious thermophilus
Kim16 parallel group, double blind RCT
IBS 48 ( 100-mm visual ana-
logue scale (VAS) abdominal bloating 24) VSL No.3
450 /
4 8 VAS
probiotics
(flatulence) 4 (p=0.014)
(p=0.011) colonic transit
111In charcoal (p=0.05)
probiotics pro-inflammatory cytokines
Bifidobacteria infantis B5624 VSL No.3 B
Bifidobacterium animalis Lactobacillus
plantarum 299V C
probiotics
51Probiotics and Irritable bowel syndrome
1.
2. probiotics
3. probiotics
probiotics
probiotics
Boyle, Robins-Browne Tang ..200618
systematic review probiotics
.. 201019 probiotics
Lactobacillus rhamnosus20
Lactobacillus rhamnosus 21
probiotics
inflammatory bowel disease
short bowel syndrome
probiotics
probiotics
probiotics
probiotics
Lactobacillus reuteri
22
52 , - 2557
probiotics
cen-
tral venous catheter probiotics jejun-
ostomy broad spectrum antibiotic probiotics
Lactobacillus
Probiotics
probiotics Bifidobacterium infantis
35624, Lactobacillus plantarum Bifidobacterium
animalis IBS-C
3 / VSL No.3
probiotics
1. Quigley EM. Therapies aimed at the gut microbiota and inflammation: antibiot-ics, prebiotics, probiotics, synbiotics, anti-inflammatory therapies. GastroenterolClin North Am. 2011;40:207-22.
2. Parkes GC, Brostoff J, Whelan K, Sanderson JD. Gastrointestinal microbiota inirritable bowel syndrome: their role in its pathogenesis and treatment. Am JGastroenterol. 2008;103:1557-67.
3. Bolino CM, Bercik P. Pathogenic factors involved in the development of irritablebowel syndrome: focus on a microbial role. Infect Dis Clin North Am. 2010;24:961-75, ix.
4. Halder SL, Talley NJ. Functional Dyspepsia: A New Rome III Paradigm. CurrTreat Options Gastroenterol. 2007;10(4):259-72.
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5. Kellow JE, Azpiroz F, Delvaux M, Gebhart GF, Mertz HR, Quigley EM, et al.Applied principles of neurogastroenterology: physiology/motility sensation. Gas-troenterology. 2006;130:1412-20.
6. Kassinen A, Krogius_Kurikka L, Makivuokko H, Rinttila T, Paulin L, Corander J,et al. The fecal microbiota of irritable bowel syndrome patients differs signifi-cantly from that of healthy subjects. Gastroenterology. 2007;133:24-33.
7. Shanahan F. Probiotics in perspective. Gastroenterology. 2010;139:1808-12.8. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irri-
table bowel syndrome. World J Gastroenterol. 2008;14:2650-61.9. Hoveyda N, Heneghan C, Mahtani KR, Perera R, Roberts N, Glasziou P. A
systematic review and meta-analysis: probiotics in the treatment of irritablebowel syndrome. BMC Gastroenterol. 2009;9:15.
10. Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics inthe treatment of irritable bowel syndrome: a systematic review. Am JGastroenterol. 2009;104:1033-49; quiz 1050.
11. Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, etal. The efficacy of probiotics in the treatment of irritable bowel syndrome: asystematic review. Gut. 2010;59:325-32.
12. OMahony L, McCarthy J, Kelly P, Hurley G, Luo F, Chen K, et al. Lactobacillusand bifidobacterium in irritable bowel syndrome: symptom responses and rela-tionship to cytokine profiles. Gastroenterology. 2005;128:541-51.
13. Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, OMahony L, et al.Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in womenwith irritable bowel syndrome. Am J Gastroenterol. 2006;101:1581-90.
14. Guyonnet D, Chassany O, Ducrotte P, Picard C, Mouret M, Mercier CH, et al.Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 onthe health-related quality of life and symptoms in irritable bowel syndrome inadults in primary care: a multicentre, randomized, double-blind, controlled trial.Aliment Pharmacol Ther. 2007;26:475-86.
15. Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized
54 , - 2557
study on the efficacy of Lactobacillus plantarum 299V in patients with irritablebowel syndrome. Eur J Gastroenterol Hepatol. 2001;13:1143-7.
16. Kim HJ, Vazguez Rogue MI, Camilleri M, Stephens D, Burton DD, Baxter K, etal. A randomized controlled trial of a probiotic combination VSL No.3 and pla-cebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil.2005;17:687-96.
17. Floch MH, Walker WA, Madsen K, Sanders ME, Macfarlane GT, Flint HJ, et al.Recommendations for probiotic use-2011 update. J Clin Gastroenterol. 2011;45Suppl:S168-71.
18. Boyle RJ, Robins-Browne RM, Tang MA. Probiotic use in clinical practice: whatare the risks? Am J Clin Nutr. 2006;83:1256-64.
19. Whelan K, Myers CE. Safety of probiotics in patients receiving nutritional sup-port: a systematic review of case reports, randomized controlled trials, andnonrandomized trials. Am J Clin Nutr. 2010;91:687-703.
20. Rautio M, Jousimies-Somer H, Kauma H, Pietarinen I, Saxelin M, Tynkkynen S,et al. Liver abscess due to a Lactobacillus rhamnosus strain indistinguishablefrom L. rhamnosus strain GG. Clin Infect Dis. 1999;28:1159-60.
21. Mackay AD, Taylor MB, Kibbler CC, Hamilton-Miller JMT. Lactobacillus en-docarditis caused by a probiotic organism. Clin Microbiol Infect. 1999;5:290-2.
22. Elias J, Bozzo P, Einarson A. Are probiotics safe for use during pregnancy andlactation? Can Fam Physician. 2011;57:299-301.
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